First time Burkholderia

Question

My son, 37, has had for the first time Burkholderia multivorans 10^3 in the sputum. Besides Pseudomonas for decades.
Does one observe this at first closely respectively is there any general procedure?
He takes azithromycin and inhales every 4 weeks colistin respectively aztreonam alternating.

Answer

Dear questioner,
You want to know, how the general procedure is in case of adult CF patients and the finding of Bukholderia mutlivorans.
Informations about Burkholderia multivorans and about many other germs in case of CF can be found in the "requirements on the hygiene for the medical care of patients with cystic fibrosis". These recommendations have been worked out from the comission for hospital hygiene and infection prevention (KRINKO) of the Robert-Koch institue (RKI) in Berlin (Germany) [guidelines are in German].
There are many (at least 10) different Burkholderia-genomovars (bacterial species) and one speks hereby about a Burkholderia cepacia-complex (Bcc). Bcc germs are like Pseudomonas aeruginosa (Pa) gram-negative infectious germs. Bcc are ubiquitious in the earth, especially at the roots of certain plants and show in general from the beginning on many resistances (against antibtiotics).
Similar to Pa it deals in case of Bcc about biofilm-building humid germs.
Bacteria of the Bcc are isolated much less frequently in CF patients than e.g. Pa or Staphylococcus aureus. However, they belong in patients with CF to the so-called "emerging pathogens" (often multiresistant germs with increasing clinical and prognostic meaning). These germs can initiate a cepaica-syndrome (with high fever, high inflammatory markers, rapid worsening of the course of the illness), more often however in CF patients who are already in a more advanced stage of the illness. In many cases the germ "accompanies" the patient without any visible influence on the course of the illness. A transmission of germs from patient to patient can happen in the hospital, however also outside the clinic via close social contacts between patients with CF.
Now I come back to your question:
1. As Burkholderia multivorans can be transmitted from patient to patient, CF patients with this germ are isolated from other CF patients in the daily clinical work.
2. From the first finding of Burkholderia multivorans on a regular microbiological control of the sputum should be done, in the beginning more often (every 4-6weeks), in case of a chronic colonization every 3 months.
3. After confirmation of the first finding, an eradication trial is done according to the antibiogram. The therapy against Pa is not affected by this, however interactions should be taken into account here.
We hope to have helped you and your son with our answer. We recommend your son to utilize the information for a talk with his CF physician and to find with him together the best diagnostic and therapeutic way concerning the colonization with germs.

With my best regards and the best wishes for the new year 2015,
for the entire CF expert panel,
Yours Dr. med. Christina Smaczny

12.02.2015